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What is Chilblains?

Discolouration of the tips of the toes

It’s the painful inflammation of small blood vessels in your skin that occur in response to sudden warming from cold temperatures. Also known as pernio, chilblains can cause itching, red patches, swelling and blistering on extremities, such as your toes, fingers, ears and nose.

Thankfully it’s something we don’t have to worry about in the Caribbean, however I’m currently at risk, given I’m in this cold weather. As a matter of fact, I know someone who got it, so I saw first-hand what it looks like. I haven’t seen any affected patients in Clinic up here yet, but winter isn’t over so some can still come in.

 

Who’s at Risk?

It mainly affects young adults working outdoors in cold places, or people who do not wear socks or tights in winter. Elderly people with poor circulation; persons who don’t exercise enough; and those suffering from anaemia, are also susceptible. People with lupus; those who smoke; or have Raynaud’s Phenomenon, are more at risk because these conditions affect your blood vessels.

Persons with Raynaud’s Phenomenon

Both conditions are related to circulation, so many people with Raynaud’s also have chilblains.  Raynaud’s is a condition in which the blood supply to the extremities, usually the fingers and toes, but sometimes also the ears and nose, is interrupted. The stimulus is usually a change in temperature or stress. During an attack they first become white and dead-looking, they may then turn blue and finally bright red. There may be considerable pain, numbness, or tingling.

 

Symptoms

If you are susceptible to chilblains, you will notice the burning and itching in the affected areas. You will next notice the typical red swellings, which may turn purple or become blisters in extreme cases.

There are two types of chilblains: chronic and acute. The chronic type lasts for at least five months of the year, for at least three years. With chronic chilblains you may also see scarring. People with the acute type usually have them only for one to two weeks.

Prevention

Doing the following is sensible for prevention:

-Keep your hands and feet warm when out in cold weather by using warm gloves and socks. Consider special heated gloves and socks if the condition is a recurring one.
-Keep your head and ears warm by wearing a hat and scarf.
-You should keep as warm as possible in the cold. Wearing several loose layers is ideal to trap body heat. You should also keep as dry as possible.
-After being out in the cold, do not heat the skin quickly with hot water bottles, gradually warm up.
-Side effects to some medicines may narrow (constrict) tiny blood vessels. This may be enough to make you prone to recurring chilblains. For example, beta-blockers can have this effect. Tell your doctor if you become prone to chilblains following the start up of any medication.
-If you are outside in the cold, keep active to improve your circulation and do not wear tight shoes; they can restrict circulation.
-Keep your skin moisturised.
-Drink hot drinks to keep your entire body warm.
-If you smoke and get chilblains, try to quit; smoking damages your blood vessels and can make them worse.

Fleece Lined BootsFootwear

People often think that the more socks and tights they wear, the warmer the feet will be. This is not really the case, as it restricts the circulation and increases the chilling of the feet. Remember, it is often the quality of the hosiery and the footwear and not necessarily the quantity, which is important. Wear thick socks and fleecy-lined shoes or boots, making sure they are not too tight fitting. Sheepskin is an ideal lining, but a synthetic lining to a leather shoe will also help. Wear slippers which cover your ankles rather than mules.

Make sure that your shoes fit well and feel comfortable. If they rub, the skin may become damaged and then infected. This can be a problem due to the poor circulation, as the time taken to heal could be much longer than normal.

Treatment

Chilblains usually go away by themselves, and are generally treated at home with simple remedies:

-Keep the affected areas warm, but not too hot (never use a hot water bottle directly on your skin.)
-Use Friar’s Balsam, or another antiseptic lotion to help reduce the chance of infection. Lanolin cream can be used at night to keep your skin soft and supple.

If you notice blisters, or if those blisters become infected, seek medical advice from your doctor or podiatrist straight away. For those of you who may have to travel to any cold country, take note; to be forewarned is to be forearmed.

Your feet mirror your general health . . . cherish them!

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